Very Long-term Outcome after Linear vs. Electrogram-guided Ablation for Persistent Atrial Fibrillation: A Propensity Score-matched Analysis

Background: The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. Methods: In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n=52) and one with PVI and EGM-guided ablation (EGM-group; n=52). Results: Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p=0.76). During 100±28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8±0.9 procedures) compared with EGM-group (Logrank test: P=0.0001 and P=0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of AAs recurrence. Conclusions: Linear ablation is a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.